Multi-drug Resistant Organism (MDRO) admission screening

Background

Screening policies

Patient screening for multi-drug resistant organisms (MDRO) on admission to hospital is key to reducing the development and spread of infections in healthcare. Early detection of high-risk patients – using a clinical risk assessment (CRA) based approach – allows early isolation while microbiological samples are tested. This reduces the opportunity for transmission if a patient is colonised or infected.

Scotland has two national acute hospital admission MDRO screening policies:

  • meticillin resistant Staphyloccus aureus (MRSA) screening
  • carbapenemase-producing Enterobacteriaceae (CPE) screening

MRSA screening programme

Staphylococcus aureus is a bacterium that colonises human skin and mucosa. Most strains of S. aureus are treated with commonly used antibiotics. However, some S. aureus bacteria are resistant to several widely used antibiotics and these are called MRSA.

Normally the bacteria don't cause harm and those colonised with S. aureus have no symptoms. But, S. aureus can lead to serious infections when bacteria spread to the bloodstream. This may occur when the skin's broken, particularly following surgery or a medical procedure. Examples of the types of infections include:

  • skin
  • wound
  • infected eczema
  • abscesses
  • joint
  • endocarditis
  • pneumonia
  • osteomyelitis
  • urinary tract
  • bacteraemia

Read our Protocol for CRA MRSA Screening National Rollout in Scotland document for more information on:

  • who gets tests for MRSA on admission to hospital
  • the questions patients are asked during the risk assessment
  • how samples are taken for testing
  • the body wash and nasal treatments MRSA carriers are given

Our patient information leaflets give further advice about MRSA screening clinical risk assessment for individuals. These leaflets are available in several different languages.

CPE screening programme

Enterobacteriaceae are part of the normal range of bacteria found in the gut. CPE are a type of this bacterial group, which are resistant to carbapenem antibiotics. They carry a gene for a carbapenemase enzyme that breaks down these antibiotics. Consequently, CPE causes infections that are associated with high rates of death and illness, and can have severe clinical consequences. Treating these infections is increasingly difficult, as these organisms are often resistant to many – if not all – available antibiotics.

Read our toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae in Scottish acute settings document for more information.

Our toolkit and advice for healthcare workers goes into more detail about:

  • who gets tests for CPE on admission to hospital
  • the questions patients are asked during the risk assessment
  • how samples are taken for testing
  • who needs antibiotics based on the test results

Our patient information leaflets give further advice about CPE screening clinical risk assessment for individuals. These leaflets are available in several different languages.

Publications

The following reports and publications listed below give an overview of several pathfinder studies into MRSA screening within NHSScotland and can be downloaded from the MRSA Screening Pathfinder Implementation Study Reports:

  • Final report executive summary
  • Final report volume 1: An investigation of the clinical effectiveness of universal MRSA screening
  • Final report volume 2: An assessment of the economics, implementation and modelling of universal MRSA screening
  • Final report volume 3: A mixed methods study of the acceptability of MRSA screening in NHSScotland pathfinder
  • Final report volume 4: To evaluate the feasibility and potential for rollout of the MRSA screening programme
  • The value of nasal swabbing versus full body screening or clinical risk assessment to detect MRSA colonisation at admission to hospital
  • Discharge testing for MRSA in Scottish hospitals: MRSA acquisition, description of acquired strains and risk factors for acquisition of MRSA in the hospital
  • NHSScotland MRSA screening programme economic analyses
  • NHSScotland MRSA screening programme update report - additional data following the completion of the pathfinder study
  • SBAR to the Scottish Government Health Directorates: Policy implications of further research studies for national rollout of MRSA screening

Additional resources

View our associated guidance of CPE in non-acute settings.

You can also read the relevant Chief Nursing Officer (CNO) and Chief Medical Officer (CMO) letters for the MRSA screening programme implementation below: